How to Keep the Patients and Employers You Worked to Win

Winning a patient panel or an employer contract is the hard part, and it is also the part practices plan for. Keeping them is where the money quietly leaks away: research suggests annual turnover can run as high as 50% without deliberate attention, and drop to 5 to 10% with it. Jason Larsen of Assurance Healthcare tells the story of calling a trucking company that had signed with a local DPC practice, only to learn they had canceled after a year because 85 employees had used the clinic three times. The fix is not complicated, and it is the same thing your grade school math teacher asked for: show your work.

If you run an independent medical practice, such as a direct primary care (DPC) clinic, then you know how hard it can be to grow your patient base. In fact, we’ve heard this from so many of you that we wrote two full eBooks on the topic: one about directly attracting new patients and another on how to land employer contracts.

But what happens when you’ve been successful and managed to build your patient panel and maybe even secure a few employer contracts? If you’re not proactively thinking about how to keep your patients and employers on board with your organization, then you risk losing all of the time and effort that you put into enticing them in the first place. Research suggests, in fact, that annual turnover can be as high as 50% without optimization, but you can reduce this number to 5 to 10% with a bit of attention.

“I once read that a local DPC practice had signed up a trucking company with 85 employees,” said Jason Larsen, CEO of Assurance Healthcare. “So I gave that company a call to ask what had attracted them to DPC and to learn how we could go after similar deals. They told me, though, that they had canceled after just a year because their employees had only used the clinic three times. Out of 85 people. So I learned from that, just not what I was expecting to learn. The DPC practice really missed the ball on something there.”

If you want to keep your patients and their employers around, you need to show them consistent value. Happily, there’s an absurdly simple way to make sure that you’re doing exactly this, and you might remember it from grade-school math class:

1. Understand the Problem
2. Provide a Good Answer
3. Show Your Work!

1. Understand the Problem

Every patient and every employer has some set of health-related problems to solve, but they may not always have them clearly defined. Because of this, whenever you start a new relationship with a patient or employer, you should spend time clarifying the issues that they’re facing and what exactly they’re trying to accomplish.

Make sure to get a good idea of their current baseline, too; you’ll need data to compare your future results against. For patients, this could mean taking measure of things like smoking status, chronic disease control, and personal health goals. For employers, it likely means understanding previous sources of high cost, missed work time, and unsatisfied employees.

Putting in the effort to identify and understand the needs of your clientele will help you establish mutual goalposts. If you don’t create a shared vision of what success means, then you risk being caught off-guard when results that seem great to you don’t meet the unexplored expectations of a patient or their employer.

This phase of problem definition also gives you a powerful opportunity. You know your organization’s medical abilities, so you know where you can best provide value. Use this insight to ensure that the goals you choose are likely to be ones that you can meet and exceed.

Don’t be shy about using technology to give yourself an edge, either. Modern health-tech platforms like Spruce can allow you to offer attractive benefits to patients and employers, such as increased patient access via phone, text message, secure messaging, and telemedicine, all without burying your team in extra work.

2. Provide a Good Answer

Once your goals are picked out, it’s time to go full steam ahead to achieve them. The most important part of this process, however, can be unexpectedly tricky: getting your patients through your door. This goes double for anybody who was added to your roster only because of an employer contract.

“We’ve started sending out welcome letters to new members,” said Mr. Larsen of Assurance Healthcare. “They all get a phone call, too, which asks them to come into clinic for a first visit to establish care. We make sure that we get them in as soon as possible after they sign up, and that’s the biggest thing for retention: getting them in to see us and making sure that they understand who we are, how we work, and what we offer.”

You can’t succeed if your patients don’t use your services. One important strategy to ensure that this occurs is to make use of “internal marketing,” which includes activities like monthly newsletters, appointment reminders, check-in messages, new service announcements, event invitations, and anything else that gives you an opportunity to communicate with your panel. It may seem strange to “advertise” to people you’ve already recruited, but you can’t achieve your promised results without your patients’ participation, and you shouldn’t passively wait for it to occur.

It can be similarly important to maintain active communication with your contracted employers so that they stay aware of your success. At Spruce, we can help practices track important metrics, such as patient message and call volume, telemedicine visit numbers, ER visits and hospitalizations avoided, patient satisfaction, and numerous other outcome measures.

You’re already doing the hard work of providing great medical care, so make sure that you collect and share the outcome data that proves it.

3. Show Your Work!

We can all remember losing points on a math problem in school because we gave a correct answer but didn’t “show our work.” It was infuriating, of course, but it also demonstrated an important lesson: Sometimes you have to prove that your outcomes are the result of good process, rather than something less dependable.

This principle holds in your relationships with patients and employers, too. You’ve put a lot of thought into how to achieve your carefully selected goals, so be proud and share your methods; make sure every key decision-maker knows how you accomplished what you did.

Did you reduce ER visits for an employer by making yourself available to patients after hours via telemedicine? Keep track of those cases! Collect testimonials. Include all of this as context when you report your results, and you’ll have a compelling story of how you got your patients from their baselines to their goals.

Did you get a patient an MRI for a cheap cash-pay price because you negotiated with a local imaging center? Did you use your in-office pharmacy to get somebody’s medication costs down to a tenth of what they used to be? Tell everyone who should be interested, and make sure that you continue to promote your methods and efforts just as much as your outcomes. Let your patients and employers know how hard you’re working on their behalf and that your results aren’t lucky or easily replicable.

You’ve got your patients and your employer contracts, but now you need to make sure that you keep them. It doesn’t have to be hard, but that doesn’t mean that it will happen automatically, either.

If you stick to the same formula that got you through fifth-grade math class, though, you should be on the right track:

Understand the problem that you need to solve, provide a correct answer, and show your work!

Frequently Asked Questions

How much patient turnover should a practice expect?

Research suggests annual turnover can be as high as 50% without deliberate attention, and can be reduced to 5 to 10% with it.

Why do employer contracts get canceled?

Usually because the employer cannot see the value. In the example here, a trucking company with 85 employees canceled after one year because the clinic had been used three times, and nobody had shown them what else the practice was delivering.

What are the three steps to demonstrating value?

Understand the problem the patient or employer is trying to solve, provide a good answer to it, and then show your work so they can see the answer you provided. Spruce helps with the last step: calls, texts, secure messages, and video visits for each patient stay in one place, so a practice can show an employer or a patient panel what it actually delivered.

Why does showing your work matter so much?

Because retention depends on perceived value, not delivered value alone. A practice can be doing good work for a patient panel or an employer and still lose the contract if nobody on the other side can point to what they received.